Denosumab in the treatment of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis
Authors Yanbeiy ZA, Hansen KE
Received 13 April 2019
Accepted for publication 24 July 2019
Published 14 August 2019 Volume 2019:13 Pages 2843—2852
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Tuo Deng
Zeina A Yanbeiy, Karen E Hansen
Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI, USA
Objective: Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis. In May 2018, denosumab was approved for the treatment of GIOP in men and women at high risk of fracture. We undertook a systematic review and meta-analysis to summarize the efficacy and safety of denosumab in the prevention and treatment of GIOP.
Methods: We searched PubMed, CINAHL, American College of Rheumatology and American Society for Bone and Mineral Research meeting abstracts for relevant studies. We included studies in which subjects were taking systemic glucocorticoid therapy and were assigned to take denosumab or control therapy, and assessed the effect of treatment on areal bone mineral density (BMD), fractures and/or safety.
Results: Three eligible studies were included in the primary meta-analysis. Denosumab significantly increased lumbar spine BMD (2.32%, 95% CI 1.73%, 2.91%, P<0.0001) and hip BMD (1.52%, 95% CI 1.1%,1.94%, P<0.0001) compared to bisphosphonates. Adverse events, serious adverse events and fractures were similar between denosumab and bisphosphonate arms.
Conclusion: Results suggest that denosumab is superior to bisphosphonates in its effects on lumbar spine and total hip BMD in patients with GIOP. There was no difference in the incidence of infections, adverse events or serious adverse events. Studies were underpowered to detect differences in the risk of fracture. Denosumab is a reasonable option for treatment of GIOP. However, further studies are needed to guide transitions off denosumab.
Keywords: denosumab, glucocorticoid-induced osteoporosis, bone mineral density, fractures, safety
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